Related Subjects:
|Shoulder Anterior Dislocations
|Shoulder:Posterior Dislocation
|Elbow Dislocation
|Olecranon Fracture
|Distal Humerus Fracture
|Radial Head and Neck Fractures
|Forearm Fractures
|Shaft of Ulna Fracture
|Wrist Colles Fracture
|Wrist Smith’s Fracture
💪 Even if reduced, patients are often admitted for elevation and regular neurovascular checks (circulation, sensation, movement) due to the high risk of swelling-related neurological deficit.
📖 Introduction
- Elbow dislocation is a common joint injury, most often from trauma (e.g., FOOSH, sports, or high-energy accidents).
- It involves displacement of the ulna and radius from articulation with the humerus.
- Early recognition and treatment are vital to prevent complications such as neurovascular injury, stiffness, and long-term instability.
⚡ Causes
- Fall on an outstretched hand (FOOSH injury)
- Direct blow or trauma to the elbow
- Sports injuries (e.g., rugby, gymnastics, wrestling)
- Motor vehicle accidents
- High-energy trauma in younger individuals
🩺 Clinical Features
- Gross deformity: loss of the normal “triangle” (olecranon + epicondyles).
- Severe pain, swelling, and reduced/eliminated range of motion.
- Assess and document neurovascular status carefully:
- Median Nerve:
- Motor ➝ thumb opposition, MCP flexion
- Sensory ➝ radial border of index finger
- Radial Nerve:
- Motor ➝ wrist extension
- Sensory ➝ dorsum of hand, radial aspect
- Ulnar Nerve:
- Motor ➝ finger ab/adduction (MCP joints)
- Sensory ➝ ulnar border of little finger
- Assess distal pulses (brachial, radial) ➝ document circulation.
- Give IV access + IV analgesia (e.g., morphine) before imaging.
- Immobilise in a broad-arm sling before reduction.
🩻 X-Ray Findings
- Request AP + lateral elbow X-ray.
- Most dislocations are posterior.
- Check for associated fractures ➝ especially radial head/neck and coronoid process.
- Fracture-dislocation: 🚫 Do NOT attempt reduction in ED — refer to orthopaedics (risk of bone fragment entrapment).
🛠️ Management
- Transfer to resus; apply monitoring.
- Consent for procedural sedation; ensure 2 doctors are present.
- Reduce with longitudinal traction + gentle flexion.
- Reassess and document neurovascular status post-reduction ✅.
- Apply a long-arm backslab before post-reduction X-ray (joints often unstable).
- Obtain a post-reduction X-ray.
- Refer to on-call orthopaedics.
⚠️ Complications
- Neurovascular injury (esp. median & ulnar nerve, brachial artery).
- Associated fractures ➝ “terrible triad” (radial head + coronoid + dislocation).
- Compartment syndrome.
- Chronic instability, stiffness, heterotopic ossification.
📅 Follow-up & Rehab
- Ortho follow-up in fracture/dislocation clinic.
- Physiotherapy ➝ early, supervised mobilisation prevents stiffness.
- Most patients recover well, but some may develop chronic instability or restricted extension.
